Obesity and Its Metabolic Complications in IVF.

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Abstract

OBJECTIVE: We aimed to assess proinflammatory state and its correlation with oocyte quality, the probability of fertilization and adequate early embryogenesis in obese and normal weight women who underwent ovarian stimulation in IVF. view more

OBJECTIVE: We aimed to assess proinflammatory state and its correlation with oocyte quality, the probability of fertilization and adequate early embryogenesis in obese and normal weight women who underwent ovarian stimulation in IVF.DESIGN: All the participantes were divided into 3 groups according to their BMI, based on WHO guidelines: group 1 (normal weight (NW)) - 79 (BMI=18.5-24.99 kg/m2), group 2 (overweight (OW)) - 43 (BMI=25.0-29.99 kg/m2), group 3 (obese (OB)) - 51 (BMI> 30.0 kg/m2). Levels of adipokines (leptin, adiponectin, IL-6, C-reactive protein (CRP)) in serum was taken on the day of oocyte pick-up. Blood samples to measure adipokines levels were taken on the day of pick-up. All the stages and aspects of IVF therapy were consistently compared among the studied groups.MATERIALS AND METHODS: All the patients underwent controlled multifollicular ovarian stimulation for assisted reproductive therapy with gonadotropins and GnRH antagonist (Cetrorelix, EMD Serono, USA). Serum blood adipokines concentration were measured using special kits for the multiplex analyzer Luminex 200 (Luminex Corporation, USA).Statistical analysis was performed using SPSS Statistics 20.0RESULTS: The OB group had significantly reduced results in every treatment stage compare to NW group: doses of gonadotropins (1500 IU vs. 1300 IU,р=0,023) and treatment duration were higher (10 vs. 9 days, p=0.02), despite of relatively similar ovarian reserve significantly fewer oocytes were collected (5 vs. 7, p=0.014), as well less mature oocytes (3 vs. 6, p=0.002), and less number of obtained blastocyst (3 vs. 6, p=0.006). The frequency of implantation in obese women was almost two times lower than in the NW group (15.9% vs. 30.2%, p=0.016), live birth rate was also decreased (p=0.056). Concentration of leptin (ρ=0.79, p<0.001), CRP (ρ=0.61, p<0.001), and leptin/adiponectin ratio (ρ=0.76, p<0.001) positively correlated with BMI and were associated with higher number of poor quality embryos on the 5th day of cultivation. The proportion of the morphologically poor quality embryos on day 5 of the cultivation in the OB group was significantly higher (p=0.013). By correlation analysis of proinflammatory cytokines concentration with BMI and the effectiveness of IVF treatment, we identified a threshold BMI of 28.5 kg/m2, above which the aseptic inflammatory process was significantly expressed and the effectiveness of treatment in the IVF program decreased.CONCLUSIONS: Aseptic inflammatory state in obese women showed negative effect on every stage of infertility treatment in IVF program. Based on the data obtained, all women with a BMI of 28.5 kg/m2 and above are recommended to reduce body weight by 10-15% before infertility treatment to normalize metabolic processes and improve treatment efficiency.

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